Delaware Health Insurance Practice Exam Free - 2026

• A. The 6 months following his Medicare Part B effective date only
• B. Any 30-day period he selects each year
• C. The month of January each year
• D. Beginning 30 days before his birthday and remaining open for at least 30 days after it

Correct answer: D. Beginning 30 days before his birthday and remaining open for at least 30 days after it

Explanation: Section 3411(a) allows a person enrolled in a Medicare supplement policy to cancel it and select another policy with the same or lesser benefits during an annual open enrollment period commencing 30 days prior to the person's birthday and remaining open for at least 30 days after it; issuers must give notice 30 to 60 days before the period begins. The 6-month Part B enrollment window is the initial guaranteed-issue period under Regulation 1501 § 14.1, not the annual birthday period; B and C are not Delaware rules. See 18 Del. C. § 3411.

• A. 12-month look-back; 12-month exclusion
• B. 6-month look-back for advice or treatment; exclusion only for losses beginning within 6 months after the effective date
• C. 3-month look-back; 3-month exclusion
• D. 24-month look-back; 6-month exclusion

Correct answer: B. 6-month look-back for advice or treatment; exclusion only for losses beginning within 6 months after the effective date

Explanation: Section 7105(c) provides that a long-term care policy (other than certain group policies) may not define a preexisting condition more restrictively than a condition for which medical advice or treatment was recommended or received within 6 months preceding the effective date, and may not exclude a loss resulting from a preexisting condition unless the loss begins within 6 months after the effective date. Twelve-month, 3-month and 24-month periods are not the Delaware standard. See 18 Del. C. § 7105.

• A. Yes, because a small employer employs no more than 50 eligible employees on at least 50% of its working days in the preceding calendar quarter
• B. No, because a small employer must have no more than 25 eligible employees
• C. No, because a small employer must have between 2 and 40 eligible employees
• D. Yes, because any employer with fewer than 100 employees qualifies

Correct answer: A. Yes, because a small employer employs no more than 50 eligible employees on at least 50% of its working days in the preceding calendar quarter

Explanation: Section 7202(33) defines a small employer as a person, firm, corporation, partnership or association actively engaged in business that, on at least 50% of its working days during the preceding calendar quarter, employed no more than 50 eligible employees, the majority employed within Delaware; affiliated companies count as one employer. Twenty-five, 40 and 100 are not the Delaware thresholds. See 18 Del. C. § 7202.

• A. $100,000
• B. $300,000
• C. $620,000
• D. $500,000

Correct answer: D. $500,000

Explanation: Section 4403(c)(2)a.2.C limits the Association to $500,000 for health benefit plans, and the aggregate cap for any one individual is also $500,000 where health benefit plan benefits are involved. The $100,000 limit applies to health coverages that are not disability income, health benefit plans or long-term care; $300,000 is the limit for disability income and long-term care insurance (and the general aggregate for other lines); the Association never pays the full $620,000 in excess of its statutory limit. See 18 Del. C. § 4403.

• A. The insured pays a fixed dollar amount for each covered service at the time of care
• B. Two insurers covering the same person coordinate so that benefits are not duplicated
• C. The insured pays the full cost of covered services until the deductible is satisfied
• D. The insured and insurer share covered costs by percentage after the deductible

Correct answer: D. The insured and insurer share covered costs by percentage after the deductible

Explanation: Coinsurance is a cost-sharing percentage. For example, after the deductible, the plan may pay a percentage and the insured pays the remaining percentage.

• A. It requires each family member to pay $2,000 before benefits begin
• B. It doubles every deductible when a new dependent is added
• C. It applies only to hospital stays
• D. Once covered expenses from family members reach $2,000 combined, the deductible is satisfied for the whole family

Correct answer: D. Once covered expenses from family members reach $2,000 combined, the deductible is satisfied for the whole family

Explanation: A family deductible caps the household's total deductible exposure. Combined covered expenses - commonly with no single member counting more than their individual deductible - satisfy it, after which the plan pays benefits for every family member as though each individual deductible had been met.

• A. To cap the total benefits the plan will pay over the insured's lifetime
• B. To limit the insured's covered cost sharing during a plan period
• C. To limit the premium the insurer may charge the insured in a plan year
• D. To set the amount the insured pays before the plan's coinsurance begins

Correct answer: B. To limit the insured's covered cost sharing during a plan period

Explanation: An out-of-pocket maximum caps the insured's covered cost sharing for a plan period. Premiums and noncovered services may not count, depending on plan terms.

• A. A fixed daily cash benefit paid to the insured for each day of hospital confinement
• B. Routine doctor visits and preventive care paid in full with no deductible or coinsurance
• C. Large or broad medical expenses subject to deductibles, coinsurance, limits, and exclusions
• D. Lost income when sickness or injury keeps the insured from working for an extended period

Correct answer: C. Large or broad medical expenses subject to deductibles, coinsurance, limits, and exclusions

Explanation: Major medical coverage is designed for a broad range of medical expenses, often including hospital, physician, surgical, and related services under the policy.

• A. Surgeon's fees paid according to a schedule of covered procedures
• B. Physician office visits and outpatient diagnostic tests covered by the policy
• C. Income lost while the insured is confined to a hospital and unable to work
• D. Room, board, and hospital-related charges covered by the policy

Correct answer: D. Room, board, and hospital-related charges covered by the policy

Explanation: Hospital expense benefits are associated with covered hospital charges such as room, board, and related inpatient services, depending on policy terms.

• A. Covered surgical procedures and related charges
• B. Physician office visits and routine preventive care
• C. Hospital room and board during a covered stay
• D. Diagnostic lab work and X-rays ordered before admission

Correct answer: A. Covered surgical procedures and related charges

Explanation: Surgical expense benefits are designed to help pay for covered surgical services, subject to the policy's limits and exclusions.

• A. They are required by law to be sold only alongside a major medical policy
• B. They may pay only specified amounts or cover only specified conditions or services
• C. They are issued on a guaranteed renewable basis and cannot exclude any preexisting condition
• D. They count as minimum essential coverage that satisfies major medical requirements

Correct answer: B. They may pay only specified amounts or cover only specified conditions or services

Explanation: Limited-benefit policies may provide narrower coverage than major medical policies. Applicants should understand what is and is not covered.

• A. How a plan calculates the coinsurance percentage the insured must pay
• B. How a network provider agrees to discount fees under a PPO contract
• C. How a plan determines an allowable charge for a covered medical service
• D. How an insurer sets the annual deductible per covered family member

Correct answer: C. How a plan determines an allowable charge for a covered medical service

Explanation: UCR concepts are used by some plans to evaluate reasonable charges for covered medical services in a geographic or market context.